Thank you very much for this opportunity to present today on professional development for advanced practice providers. I intend to provide an argument for creating the opportunity for AP advancement to increase retention, satisfaction, and professional growth. The objectives are to discuss reasons for burnout or attrition and the financial benefits of increasing retention. I will elaborate on pathways for professional development and briefly discuss relationship building. I have no disclosures, but I do want to acknowledge my biases and privilege. I have two supportive and invested supervising physicians in my career. Roy Brower and Robert McIntyre cared about me as an individual, a clinician, and an APP. They guided me professionally and personally, and I am forever indebted to them. I am also employed by an institution that supports APPs in leadership roles where APPs are faculty in the School of Medicine with similar opportunities for promotion, representation, and appreciation that are comparable to our physician colleagues. I understand and acknowledge that this is unfortunately inconsistent across the country. A subset of respondents from McKinsey's 2020 Great Attrition, Great Attraction 2.0 Global Survey found that 41% resigned from their previous position due to a lack of career development and advancement. Another significant reason specified is uncaring leaders followed by a lack of meaningful work. Although not specific to healthcare, the message can be extrapolated, and healthcare is unlikely to be isolated from these factors. These are key areas where physician and APP leaders can make a huge impact. If most respondents indicated a lack of career development and advancement, this seems like an essential area of focus. With this, it can be extrapolated and argued that meaningful work and caring and inspiring leaders will surely follow. APP resignation is not only a detriment to patient care, it also exacerbates burnout for the remaining staff needing to compensate for unmet responsibilities. Additionally, there are both direct and indirect costs associated with turnover. According to this 2022 New England Journal of Medicine Catalyst article, the turnover rate is approximately 12%, with an average estimated cost of $100,000 per provider. This does not directly account for lost recruitment or lost money productivity related to recruitment and onboarding. The model or path you wish to pursue for APPs is less important than providing the opportunity. Leaving APPs in the dark without a guiding light will result in attrition, dissatisfaction, and a lack of investment in the unit, exacerbating stress, burnout, and worsening retention. This is the opportunity to break the cycle and to make a difference. There are many options for professional development or advancement for APPs, including teaching, research, industry, or administration. I advocate for developing a system to foster growth while remaining mostly clinical so we can decrease attrition while recognizing excellent APPs. I also advocate for a system that will foster growth while remaining mostly clinical so we can decrease attrition while recognizing excellent APPs. Examples of opportunities for professional development and mentorship exist and are easy to support. They just require effort and investment, but the return of keeping experienced providers is incredibly valuable. The model utilized for development matters less than the key components. The examples of criteria for fellowship in the American College of Critical Care Medicine or faculty promotion guidelines are easily reproduced and supported by any institution. Is there an APP on an important school of medicine committee? Could or should there be? Too often there's a physician and a nursing collaboration without APP recognition. Is there encouragement to publish work being done? It just takes a little nudge to get someone to fly. I would argue that scholarship is likely the most intimidating part of advancement for APPs based on training but can be overcome with encouragement. Just as students and residents are encouraged to publish or present, APPs should be included in similar activities. A memorable tweet discussed making scholarship out of your daily work and it focuses and reminds me every day. An interesting case or presented case conference can become a case report. An interest, saw a cool image, endoscopic or pathologic or radiologic, publish a clinical image. A core lecture on a topic can turn into a review article. Room for improvement becomes a quality improvement project. Curious about a clarification in a study? Send a letter to the editor. Recognize a pattern not described before? This can become a retrospective study. Or did you develop an interesting program idea for teaching conferences, rounds in your ICU? This is educational research. The opportunities present themselves daily but recognition and motivation to create is imperative. As I mentioned before, I am fortunate to both be faculty in the School of Medicine and eligible for promotion and re-designation in my position. I'm currently an assistant professor in surgery and critical care and I'm eligible for further promotion. I was initially hired at the instructor level and promoted to senior instructor prior to re-designation as an assistant professor. Many iterations of this guide were required prior to approval and there is still resistance to implementation and adoption. There is now even a committee on increasing equity for promotion for all members of the School of Medicine, including social workers, genetic counselors, research scientists, and many others. It is still worth the effort and the University of Colorado is neither a pioneer or alone in this process. However, there are very few institutions that have APPs eligible for promotion and re-designation as assistant associate or full professor in their School of Medicine as clinical faculty. There are two outstanding articles related to professional advancement for APPs that I wish to highlight today. A 2018 article in the Journal for Nurse Practitioners entitled Professional Advancement for Advanced Practice Clinicians discussed a promotion plan at the University of Maryland Medical Center Baltimore. Based on survey data of 300 APPs, including nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and physician assistants. The survey demonstrated a lack of professional advancement opportunities. Within two years of the survey, the organization developed and implemented a four-tier professional advancement model that included four domains, clinical expertise, leadership and policy, research and evidence-based practice, and education. One year post-implementation, APP turnover decreased from year one to year three from 13.8% to 5%. A subsequent 2021 article from the Journal of Nursing Practice titled Supporting Advanced Practice Providers Professional Advancement, the implementation of a professional advancement model at an academic medical center was thoughtfully published out of the Ohio State University. They report immediate gains such as increased APP visibility within the organization as well as externally. More APPs were presenting at APP Grand Rounds, publishing more in a peer-reviewed journals, and presenting at conferences both locally and nationally. While the professional advancement program is likely not the sole contributor, there's decreasing turnover at their institution from 22% before implementation to 5% at the time of publication. The decrease in turnover had a significant positive financial impact for the institution, which supports the cost of the advanced practice provider professional advancement model. Even if the opportunities for promotion or advancement exist, there's at least one additional step. Most APPs require mentorship, advising, and coaching, which can all be done simultaneously. These three roles were recently re-emphasized by Dr. Kaplan during the SCCM webinar titled, Is Mentorship Obsolete in Our Modern Healthcare Environment? If you did not attend, I strongly encourage you to listen to the recording on the website. I am here to encourage you to be the one. The National Scientific Council on the Developing Child emphasizes the importance of having one stable, caring relationship between a child and an adult. I see important parallels, as I often do trading between leadership and parenting books. Our mentor, one mentor, one invested colleague, one leader can be the difference in the career of an APP. The satisfaction from being that person is incredible. However, it does take two to ensure a cooperative relationship. Mentorship is rarely taught in school and during professional advancement. There are guides on what makes a good mentor, but increasingly more emphasis on the mentee as well. It is a relationship that takes work on both parties to be successful. I do want to acknowledge that mentorship can both exacerbate and decrease burnout. In a presentation out of the Children's Hospital Colorado, providing peer support diminished feelings of burnout among the providers of peer support in addition to the recipients. Limits can and should exist on mentorship, it takes time, energy, and effort. However, relationships can be mutually beneficial for promotion and advancement for both advanced practice providers and physician colleagues. If an APP and physician or two APPs collaborate on a project presentation, both get credit for it, for promotion, which leads to the success of both participants. The promotion and development of APPs does not have to impact physician colleagues. It's not a competition or pie. There is room for everyone and when shared increases collaboration, safety, quality, and retention of experienced providers in our ICUs. Providing mentorship and professional advancement is complex. It takes strategy, skill, time, and an initial investment. However, the personal, monetary, and time rewards can significantly outweigh the costs. Thank you for the opportunity to discuss today.

professional development

advanced practice providers

retention

career development

mentorship